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R f tW E D SAN JOAQUIN COtm SHO LOG NUMBER <br /> ENVMONMENTAL HEALTH DEPARTMENT <br /> APR 2 9 20�04pg 304 E Weber-Ave 3rd Floor Stockton,CA 95205 <br /> ENVIRONMENT HERN468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/ehd I Q� <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION U <br /> APPLICANT: BUSINESSIAGENC�Y: 1 <br /> tJ <br /> ADDRESS:17, 4 lggt'A1.Y I [ Lrtr �Wl� ulpl GirtK2 <br /> PHONE:1 'yj2-1FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: T(�; <br /> (Plaaaa allow 10 bwlnass days from data of appikaaon submkial) <br /> 13 CHECK BOX TO EXPEDITE RE� EST-823 'E—RE UEST PROCESSED IN a BUSINESS DAYS - •/ �` <br /> SIGNATURE OF APPLIC _ DATE ,4q 0%4 <br /> De y 1'1Iyt. nyl <br /> iIL�L.I�I FILE ADDRESS UNIT ��"\a 4 <br /> � Uniti f. s� <br /> �wl —� htAr+i v Lf� [( be <br /> [J Unit 2 ag 1 A <br /> s. sysx . 1I <br /> s. 9aret /N . <br /> z Ono <br /> e. se.e1 <br /> e. seen <br /> o sal1771Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT rl SOLID WASTE FACILITY <br /> X OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MOWTORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> fIT HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH D PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTDOISODY PIERCING ❑ POOLISPA D LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt Of application, The flies <br /> will be hell for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly, <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant Future file reviews by the same applican may requ re a$93_o0elepos�noi to review, <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD II-0S-0OG <br /> uazow <br /> 000 T00 1103US 059TZLCSZ6 %V3 S4;tT MU f0/13Z/60 <br />